Danique J.J. van Gulick,¹ Martijn M. Stuiver², Cees Lucas², Marike van der Leeden².
¹RondOm Podotherapeuten, ²Amsterdam UMC

ABSTRACT

Background

Pressure platforms are valuable tools in the assessment of foot function and postural stability in neuropathic diabetic patients. For use in clinical practice, reliability is paramount. Therefore, we recently developed a standardized measurement protocol, and demonstrated that pressure data could be reliably obtained using the FootWork Pro® platform in healthy adults. However, in patients with diabetes mellitus, impairments in foot function and health characteristics may impact the measurement properties of the protocol.

Research question

Can a standardized measurement protocol that uses the FootWork Pro® platform obtain reliable pressure data in neuropathic diabetic patients? How do variations in the protocol affect reliability?

Methods

Cross-sectional study among neuropathic diabetic patients (n=58), in a clinical setting. We collected six static COP parameters under four different conditions (eyes open for 30 seconds and 60 seconds, and eyes closed for 30 and 60 seconds), and five dynamic parameters each in eight anatomical regions of interest during two testing sessions, with one week in between. Intra-session (i.e., within session) and inter-session (i.e., between sessions) reliability were assessed using intraclass correlation coefficients (ICCs), and standard errors of measurement (SEMs). We conducted up to three trials (static) and five steps (dynamic), to determining the required number of measurements.

Results

Two trials are sufficient to obtain reliable intra-session values for all static COP parameters, while three trials are required for inter-session. We found comparable ICCs for different sample durations, and higher ICCs for eyes closed versus eyes open. All dynamic parameters could be reliably retrieved by averaging four steps. However, some dynamic parameters in less-loaded regions showed high SEMs, up to 76.2% of the median.

Significance
A wide range of static and dynamic pressure parameters could be reliably obtained in neuropathic diabetic patients when applying a standardized protocol using the FootWork Pro® platform. We recommend averaging three trials for obtaining static pressure parameters, and four steps for obtaining dynamic pressure variables.